Adherence research in the behavioral and social sciences is relevant to the nation's health and well-being. Poor adherence to prescription medications and treatments has been labeled a "worldwide problem of striking magnitude" (World Health Organization, 2003). Research over the last 40 years has documented universally poor adherence to prescription medications and behavioral treatments (e.g., diet change for hypertension, smoking cessation and screenings for cancer). For example, up to 20% of patients fail to fill new prescriptions and 50% of people with chronic health conditions discontinue their medication within six months. Adherence to behavioral and biobehavioral treatments is also poor. For example, no more that 30% of patients quit smoking at their provider's request, even those affected with lung conditions. Access to medical care is vitally important, but if people do not comply with their professional recommendations, then mere access will not lead to better health outcomes. Thus, generating innovative methods to enhance adherence has become increasingly more important because:
- Treatments have become more efficacious;
- High rates of chronic diseases in the aging population often require patients to follow complex medication and treatment regimens;
- Poor adherence to medication and treatment regimens lead to poor health outcomes and increased medical costs;
- Maintenance of healthy lifestyle behaviors (e.g., smoking abstinence, maintaining a healthy body weight) may reduce the prevalence and incidence of many diseases;
- People are increasingly resorting to complementary and alternative approaches to treatment, and little it known of the role of adherence in these forms of treatment as well as how involvement in alternate forms of care affects adherence to conventional medical regimens;
- Primary responsibility for treatment adherence has traditionally focused on the patient, but because of cultural and economic challenges within health care systems, compliance to the medical regimen is shifting to secondary caregivers and others.
Despite the convergence of these factors, research still describes poor rates of adherence across diseases and populations (World Health Organization, 2003). Further, a recent Cochrane review of interventions to improve adherence (Haynes et al., 2008) found that most published intervention trials produced little improvement in adherence rates or enhancement of patient outcomes. Closer review of available research suggests that many studies included small samples of volunteers, which may have resulted in sampling bias or insufficient power to detect any benefit (Haynes et al.). In addition, most of the earlier work on interventions to improve adherence has involved studies that were of relatively short duration, did not include clinical outcomes, or failed to measure the durability of the effect once the intervention ended (Haynes et al.). These shortcomings, as well as the clinical imperative to improve health care outcomes, speak to the need for a transformative science of adherence. OBSSR along with a network of professionals within NIH form the Adherence Research Network. The Adherence Network is working to encourage research and ascertain how best NIH can disseminate information on evidenced-based methods for improved adherence. See more information about the Adherence Network and the results of a recent Request for Information at the OBSSR Adherence Research Network page.
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A search of Medline reveals thousands of articles on the topic of adherence and compliance so we clearly will not include those here. However, we have listed some summary reports that act as a baseline for current issues in adherence. As these documents were produced outside of NIH, the NIH cannot endorse the conclusions or recommendations. These documents provide comprehensive reviews of the topic.
Enhancing Prescription Medicine Adherence: A National Action Plan, August 2007
National Council on Patient Information and Education. Washington, DC.
Adherence to Long-term Therapies: Evidence for Action, 2003
World Health Organization, ISBN 92 4 154599 2
Cochrane Collaboration Reviews include many adherence topics, such as:
Interventions for enhancing medication adherence, 2008.
Haynes RB, Ackloo E, Sahota N, McDonald HP, Yao X. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD000011. DOI: 10.1002/14651858.CD000011.pub3
Interventions to Improve Adherence to Lipid Lowering Medication, 2010. Schedlbauer A, Davies P, Fahey T. Cochrane Database of Systematic Reviews 2010, Issue 3. Art. No.: CD004371. DOI: 10.1002/14651858.CD004371.pub3
Interventions for Improving Adherence to Treatment Recommendations in people with Type 2 Diabetes Mellitus, 2005. Vermeire EIJJ, Wens J, Van Royen P, Biot Y, Hearnshaw H, Lindenmeyer A. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD003638. DOI: 10.1002/14651858.CD003638.pub2
Deborah Young-Hyman, Ph.D.